Effects of lifestyle interventions on clinical characteristics of patients with non-alcoholic fatty liver disease: A meta-analysis
Effects of lifestyle interventions on clinical characteristics of patients with non-alcoholic fatty liver disease: A meta-analysis
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DOI：
10.1016/j.metabol.2016.12.006
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发表时间：
2017-03-01
影响因子：
9.8
通讯作者：
Kontogianni, Meropi D.
中科院分区：
文献类型：
--
作者：
Katsagoni, Christina N.;Georgoulis, Michael;Kontogianni, Meropi D.
背景/目标。虽然生活方式的改变仍然是非酒精性脂肪肝（NAFLD）的基石治疗，但最佳生活方式干预仍然存在争议。这项荟萃分析的目的是评估运动和/或饮食干预，运动类型或强度和饮食类型对肝功能结果（肝酶，肝内脂肪和肝组织学）的影响，以及对NAFLD患者的人体测量和葡萄糖代谢参数的影响。在Scopus和美国国家医学图书馆数据库中进行文献检索，以识别2005年1月至2016年8月期间发表的所有通过成像技术或肝活检诊断的NAFLD成人患者的随机对照临床试验（RCT）。采用科克伦偏倚风险工具评价研究质量。使用Cochran's Q检验测试异质性，并通过I-2测量不一致性。效应量计算为标准化平均差异（SMD）。按照PRISMA指南进行Meta分析。纳入了20项随机对照试验，共纳入1073例NAFLD患者。Compared.to标准治疗、运动可改善血清丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）（均P < 0.05）。肝内脂肪也得到改善，与体重变化无关（SMD =-0.98，95%CI：-1.30至-0.66）。关于运动类型，有氧运动与抗阻运动相比，对肝脏参数没有产生任何上级改善，而中到高容量中等强度连续训练比连续低到中等容量中等强度训练或高强度间歇训练更有益。运动和饮食相结合的干预措施显示ALT下降（P < 0.01）和NAFLD活动评分改善（SMD =-0.61，95%CI：-1.09至-0.13）。与低/中脂肪饮食相比，中等碳水化合物饮食产生了类似的肝酶变化。运动单独或结合饮食干预改善血清肝酶和肝脂肪水平或组织学。即使在没有体重减轻的情况下，运动也对肝内甘油三酯产生有益的影响。(C)2016 Elsevier Inc. All rights reserved.
Background/Objectives. Although lifestyle modifications remain the cornerstone therapy for non-alcoholic fatty liver disease (NAFLD), the optimal lifestyle intervention is still controversial. The aim of this meta-analysis was to evaluate the effect of exercise and/or dietary interventions, type or intensity of exercise and type of diet, on liver function outcomes (liver enzymes, intrahepatic fat and liver histology), as well as on anthropometric and glucose metabolism parameters in NAFLD patients.Subjects/Methods. Literature search was performed in Scopus and US National Library of Medicine databases to identify all randomized controlled clinical trials (RCTs) in adult patients with NAFLD, diagnosed through imaging techniques or liver biopsy, published in English between January 2005 and August 2016. Studies' quality was evaluated using the Cochrane Risk of Bias Tool. Heterogeneity was tested using the Cochran's Q test and measured inconsistency by I-2. Effect size was calculated as the standardized mean difference (SMD). The meta-analysis was performed in accordance with PRISMA guidelines.Results. Twenty RCTs with 1073 NAFLD patients were included. Compared.to standard care, exercise improved serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (all P < 0.05). Intrahepatic fat also improved, irrespectively of weight change (SMD = -0.98, 95% CI: -1.30 to -0.66). Regarding the type' of exercise, aerobic compared to resistance exercise did not yield any superior improvements on liver parameters, whereas moderate-to-high volume moderate -intensity continuous training was more beneficial compared to continuous low-to-moderate-volume moderate-intensity training or high intensity interval training. Interventions combining exercise and diet showed decreases in ALT (P < 0.01) and improvement in NAFLD activity score (SMD = -0.61, 95% CI: -1.09 to -0.13). Moderate-carbohydrate diets yielded similar changes in liver enzymes compared to low/moderate-fat diets.Conclusions. Exercise alone or combined with dietary intervention improves serum levels of liver enzymes and liver fat or histology. Exercise exerts beneficial effects on intrahepatic triglycerides even in the absence of weight loss. (C) 2016 Elsevier Inc. All rights reserved.